The findings of a major international clinical trial EFFORT, recently presented at a conference hosted by Aga Khan University (AKU), offer new hope for the global fight against Plasmodium vivax malaria – the most prevalent strain in Pakistan accounting for over 80% of cases in the country. The results hold significant promise for transforming how the disease is treated and, ultimately, eliminated.
Plasmodium vivax poses a particular challenge to malaria control because it can lie dormant in the liver and cause relapses weeks or months after the initial infection. In Pakistan, one of the greatest hurdles to malaria control is ensuring that patients complete their full course of treatment — making effective and simpler treatment options urgently needed.
The five-year trial compared three treatment approaches: the current global standard of low-dose primaquine (taken over 14 days), a shorter, high-dose primaquine regimen (7 days), and a single-dose of tafenoquine. Conducted in Karachi and Thatta — two malaria hotspots in Sindh — the trial’s findings were clear: the latter two treatments significantly reduced the rate of malaria recurrence, with tafenoquine showing particularly strong potential for malaria control in Pakistan.
“Malaria is more than just a disease — it’s an economic, political, and social challenge,” said Prof Kamala Thriemer, a global malaria expert from the Menzies School of Health Research and chief investigator for the EFFORT trial. “What made this trial unique was our commitment to testing treatment options as close to real-world conditions as possible. We focused on unsupervised regimens and tracked patients over time, including treating recurrences.”
The event included a panel discussion featuring representatives from the federal government, the provincial governments of Sindh and Baluchistan, AKU, and international experts. Together, they explored how to translate these findings into concrete policy changes and implementation strategies — from domestic drug manufacturing to funding, training, and public outreach.
Prof Dr M. Asim Beg from AKU highlighted the human impact behind the data. “We are proud to serve communities like Thatta — some of the most impoverished, but also the most resilient, in the country. Achieving elimination will take collective willpower and a unified approach at every level.”
The EFFORT trial was conducted by a consortium of partners including the Menzies School of Health Research, MORU Tropical Health Network, Maastricht University, The University of Melbourne and AKU. The trial was funded by the Bill & Melinda Gates Foundation, and Australia’s National Health and Medical Research Council (NHMRC). Its findings are expected to influence global treatment recommendations by supporting the rollout of more effective radical cures.
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